Lip G Y, Rumley A, Dunn F G, Lowe G D
Department of Cardiology, Stobhill Hospital, Glasgow, UK.
Int J Cardiol. 1995 Oct;51(3):245-51. doi: 10.1016/0167-5273(95)02434-x.
Cardioversion of atrial fibrillation carries a serious risk of major thromboembolism and stroke. To determine whether or not the procedure alters plasma levels of fibrin D-dimer (a marker of intravascular fibrin turnover and thrombus formation) and plasma fibrinogen (associated with stroke and thromboembolism), we performed a prospective study in 19 patients with atrial fibrillation in whom cardioversion was attempted: seven patients without prior oral anticoagulant therapy (but with intravenous heparin for 24 h) (Group I), and 12 patients with full oral anticoagulation pre- and post-cardioversion (Group II). Plasma fibrinogen and fibrin D-dimer were measured pre-cardioversion, and at Days 3, 7 and 14 post-cardioversion. In Group I, there was a significant reduction in median plasma fibrin D-dimer levels by 14 days following cardioversion (200 vs. 52 ng/ml; paired Wilcoxon test, P = 0.02). In Group II, there was no change in median plasma fibrin D-dimer levels over the 14 days following cardioversion. There were no significant changes in plasma fibrinogen with cardioversion in either group of patients. The reduction of plasma fibrin D-dimer in Group I suggests a beneficial reduction of intravascular fibrin turnover and thrombogenesis by the cardioversion of patients with atrial fibrillation to sinus rhythm. Furthermore, it strongly suggests that it is atrial fibrillation itself which is the major risk of thromboembolism and that the risk continues for up to 14 days post-cardioversion. In Group II, the low pre-cardioversion fibrin D-dimer levels and lack of change with cardioversion is consistent with the prophylactic effect of warfarin therapy against thromboembolism during the cardioversion of atrial fibrillation.
心房颤动复律存在严重的重大血栓栓塞和中风风险。为了确定该操作是否会改变血浆纤维蛋白D - 二聚体（血管内纤维蛋白周转和血栓形成的标志物）和血浆纤维蛋白原（与中风和血栓栓塞相关）的水平，我们对19例尝试进行复律的心房颤动患者进行了一项前瞻性研究：7例未接受过口服抗凝治疗（但接受了24小时静脉肝素治疗）的患者（第一组），以及12例在复律前后均接受充分口服抗凝治疗的患者（第二组）。在复律前、复律后第3天、第7天和第14天测量血浆纤维蛋白原和纤维蛋白D - 二聚体。在第一组中，复律后14天血浆纤维蛋白D - 二聚体水平中位数显著降低（200 vs. 52 ng/ml；配对Wilcoxon检验，P = 0.02）。在第二组中，复律后14天血浆纤维蛋白D - 二聚体水平中位数无变化。两组患者复律后血浆纤维蛋白原均无显著变化。第一组血浆纤维蛋白D - 二聚体的降低表明，心房颤动患者复律为窦性心律可有益地减少血管内纤维蛋白周转和血栓形成。此外，这强烈表明心房颤动本身就是血栓栓塞的主要风险，且该风险在复律后持续长达14天。在第二组中，复律前纤维蛋白D - 二聚体水平较低且复律后无变化，这与华法林治疗在心房颤动复律期间预防血栓栓塞的作用一致。
